Simultaneous recordings of electromyography of the external urethral sphincter and bladder pressure during voiding were done for 71 male patients with spinal cord injury. Discordant activities between the anal and the external urethral sphincters were noted in 39 per cent of the patients. The degree of bladder dysfunction was related more to the degree of dyssynergia of the urethral than the anal sphincter. This detrusor-sphincter dyssynergia was found in 67 per cent of our patients regardless of the differences in cystometric patterns and the level of spinal injury. The importance of electromyography of the external urethral sphincter in the diagnosis of neurogenic bladder dysfunction was stressed. The management of detrusor-sphincter dyssynergia is discussed briefly.
The genesis of the cystourethrographic appearance of external sphincter spasm in 11 paraplegics with complete lower motor neuron bladders was examined. By the demonstration of its close association with a postural increase in the urethral pressure and catecholamine release, and its responsiveness to alpha-adrenolytic drugs an external sphincter spasm was suggested to be a result of sympathetic dyssynergia in the region of the external sphincter. The smooth muscular component in this region is believed to be a responsible unit of this disorder, since its surgical ablation by means of radical transurethral resection of the prostate uniformly resulted in the relief of sympathetic dyssynergia. The clinical implication of this disorder in the management of vesical dysfunction of the lower motor neuron type is discussed.
The incidence and type of congenital anomalies associated with childhood testicular germ cell tumors were studied retrospectively in 25 patients (20 cases of yolk sac tumor and 5 cases of teratoma). Congenital anomalies were observed in 3 patients with yolk sac tumors and in 1 patient who had a mature teratoma. The abnormalities observed included individual cases of retrocaval ureter, diverticulum of the bladder, Down's syndrome and an ipsilateral inguinal hernia. Children with a testicular tumor should be examined closely for congenital abnormalities.
We herein report our experience with radical transurethral resection of the prostate in 50 paraplegics refractory to conventional conservative therapy, including the use of alpha-adrenolytic drugs and clean intermittent self-catheterization. The operation was successful in 46 patients (92 per cent) and unsuccessful in 4 tetraplegics with complete high cervical lesions. We discuss the rationales of this procedure for neurogenic dysfunction of the bladder and present urodynamic changes in the successful and unsuccessful cases. This extensive and, yet, microsurgically anatomical resection of the urethral sphincter is recommended for all refractory paraplegics except for complete tetraplegics with high cervical lesions.
Clinical and urodynamic studies of urethroprostatic reflux were performed in 15 of 40 paraplegics subjected to voiding cystourethrography in the last 5 years. Failure of the external urethral sphincter to relax was confirmed in all patients by either sphincter electromyography or documentation of sympathetic dyssynergia, and high pressure in the prostatic urethra was confirmed by measurement of voiding pressure. A shrewd search for this simple radiographic sign was suggested in the followup of paraplegics because it often served as an early indicator of exposure of the urinary system to the brunt of voiding under high pressure, which presently is believed to be more detrimental to the patients than residual urine. We discuss briefly an anatomical basis for its occurrence preferentially in the peripheral lobe as well as in the central lobe of the prostate in some advanced cases.
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